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Abstract
Recent retrospective studies have found high fresh frozen plasma (FFP) to packed red
blood cell (PRBC) ratios during trauma resuscitation to be associated with improved
mortality. Whilst this association may be related to a mortality bias present in these
studies, there has been an overall tendency towards a 1:1 FFP:PRBC ratio in massive
transfusion guidelines worldwide. The aim of this study was to retrospectively review
the administration of FFP in patients undergoing massive transfusion during trauma
resuscitation, to add to the evidence base for massive transfusion guidelines.
Multi-trauma patients who were administered blood transfusions of 5units or more of
packed red blood cells (PRBCs) in the first 4h were included in this study. Mortality
was the primary endpoint with length of hospital stay, ICU hours and mechanically
ventilated hours secondary endpoints.
There were 331 patients included in this study with a median Injury Severity Score
(ISS) of 36 (25-50) and a mortality of 29.9%. There was little change in the ratio
of FFP:PRBC transfused per patient from 2005 to 2008. A low FFP:PRBC ratio in the
first 4h of resuscitation, older age, low initial GCS and coagulopathy on presentation
were significant independent factors associated with mortality. When deaths in the
first 24h were excluded, the FFP:PRBC ratio had no association with mortality.
This study has shown increased initial survival in association with higher FFP:PRBC
ratios during massive transfusion in a population with a high proportion of blunt
injuries. The association is difficult to interpret because of an inherent survival
bias. The optimal ratio of FFP:PRBC during massive transfusion may be different to
1:1 and further prospective research is required. There is now an increasing need
for well designed randomised controlled trials to determine the best FFP:PRBC ratio
for the resuscitation of blunt multi-trauma patients.